The US President’s Emergency Plan for AIDS Relief (PEPFAR) supports HIV prevention in most HIV endemic countries. Programs provide partner notification services (PNS) or index testing as an HIV case finding strategy.Data is collected on PNS, contacts of index cases and HIV indicators as Monitoring, Evaluation and Reporting (MER) data.These data measures progress towards HIV epidemic control by reaching the first UNAIDS 90.
To evaluate progress towards reaching the 1st 90, we performed a descriptive analysis of MER data reported by 9 countries during October 2018-March 2019 through a Data for Accountability, Transparency and Impact Monitoring database. The 9 countries were prioritized based on HIV prevalence and the need to scale up HIV prevention activities. The five variables selected represent key elements of the HIV testing cascade indicators.
Three countries that were within 6% of achieving the 1St 90 (Namibia 4%, South Africa 5%, Rwanda 6%) had the lowest proportion of HIV-positive cases who accepted partner notification services (Namibia 66%, South Africa 52%, Rwanda 28%). In contrast, countries that had a larger gap to the 1st 90 target (Mozambique 18%, Nigeria 23%, Cote d’Ivoire 40%) showed a higher index case acceptance (Mozambique 87%, Nigeria 74%, Cote d’Ivoire 94%). Three countries met the PEPFAR benchmark of 1.5 contacts per index (Namibia 1.6, Uganda 1.7, Mozambique 1.5) but only two countries showed a high percentage of HIV positives as a result of the index exposure to contacts (Namibia 98%, Mozambique 94%). Despite being high HIV prevalence countries (Eswatini 27.4%), (Namibia 12.1%), (South Africa 18.8%) and closest to the 1st 90, these countries reported low HIV pos per 100 index (Eswatini 14, Namibia 19, South Africa 3).
These findings suggest that select countries closer to achieving the 1st 90 target with high HIV burden (Namibia, Southern Africa and Rwanda) tend to have a lower rate of index case acceptance. However, index testing is an important modality for countries that have a large gap to achieving the 1st 90s. Non-aggregated data within these countries should be evaluated to fully understand the most effective modality in each country.